Healthcare Provider Details

I. General information

NPI: 1447394945
Provider Name (Legal Business Name): ALTOS PEDIATRIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 ALTOS OAKS DR
LOS ALTOS CA
94024-5403
US

IV. Provider business mailing address

842 ALTOS OAKS DR
LOS ALTOS CA
94024-5403
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-0550
  • Fax: 650-941-6751
Mailing address:
  • Phone: 650-941-0550
  • Fax: 650-941-6751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: CHRISTINE GARDNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 650-941-0550